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Elevated Voriconazole Level Associated With Hallucinations and Suicidal Ideation: A Case Report
Jeffrey W Jansen1, Sumon K Sen2, Ryan P Moenster2,3
1PGY2 Infectious Diseases Pharmacy Resident and.
Open Forum Infectious Diseases
|May 9, 2017
Summary
Voriconazole antifungal medication can cause hallucinations. A patient on voriconazole for aspergillosis developed visual hallucinations and suicidal thoughts, linked to high drug levels and a specific genetic marker.
Area of Science:
- Pharmacology
- Mycology
- Clinical Toxicology
Background:
- Voriconazole is a broad-spectrum triazole antifungal agent used to treat invasive fungal infections.
- Pulmonary aspergillosis is a serious fungal infection that can affect the lungs.
Observation:
- A patient undergoing treatment for pulmonary aspergillosis with voriconazole experienced adverse neurological effects.
- These effects included the onset of visual hallucinations and new suicidal ideation with a specific plan.
Findings:
- The patient exhibited supratherapeutic voriconazole trough levels, measuring 9.0 mcg/mL.
- Genetic analysis revealed the patient was positive for the CYP2C19*1/*2 allele, a known factor influencing voriconazole metabolism.
Implications:
- This case highlights the potential for voriconazole-induced neuropsychiatric adverse events, including hallucinations and suicidal ideation.
- Supratherapeutic drug levels and CYP2C19 genetic polymorphism may predispose patients to these severe side effects.
- Clinicians should monitor voriconazole levels and consider genetic factors in patients presenting with neurological symptoms during treatment.
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